Acute Renal Failure Due To Light Chain Cast Nephropathy

Abstract

Myeloma cast nephropathy, also known Bence Jones cast nephropathy or myeloma kidney is the most common form of renal disease associated with multiple myeloma. Clinically, it may present as progressive renal insufficieny or acute renal failure. We describe a case of multiple myeloma who presented with acute renal failure due to light chain cast nephropathy and had a primary diagnosis made by renal biopsy. A renal biopsy was performed for acute renal failure in a 44 year old female patient. The renal biopsy showed numerous dilated tubules filled with pink eosinophilic fractured casts surrounded at places by multinucleated giant cells and accompanied by moderate interstitial infiltrate consisting of lymphomononuclear cells. There was tubular atrophy with interstitial fibrosis. The renal biopsy is occasionally the first test indicative of myeloma in a patient with acute renal failure of seemingly unknown origin. Thus the microscopic appearance of the tubules in this biopsy is easy to appreciate and is diagnostic of light chain cast nephropathy.